Key to successful care of pregnant women with heart failure? Team care, find a study

Key to successful care of pregnant women with heart failure? Team care, find a study

Whenever a pregnant woman has heart failure, the mother and baby are at risk. What does it take to protect the growing mother and baby in order to get the best results?

According to Intermountain Healthcare clinicians in Salt Lake City, the key to survival is a multidisciplinary team approach, involving specialists in cardiology and maternal, fetal / newborn health – who typically do not work together – to team up to save mother and baby.

In a case study presented on March 16 at the American College of Cardiology's scientific sessions in New Orleans, clinicians from the Intermountain Healthcare Heart Institute showed how multiple medical teams in several different disciplines had saved the life of the mother and the child after his transfer. a smaller local hospital.

"This case represents a huge team effort and shows what it takes to see a seriously ill patient throughout a unique and very difficult disease," said Kismet Rasmusson, DNP, FNP , from the Intermountain Healthcare Heart Institute.

The 36-year-old patient was 22 weeks pregnant when she arrived at an Intermountain hospital with shortness of breath but no history of heart disease.

When the doctors realized that her heart was out of order – either from idiopathic cardiomyopathy of unknown cause or from pregnancy-related cardiomyopathy – she was transferred to the Central Cardiology Institute. Medical Intermountain.

Cardiomyopathy leads to heart failure – a heart muscle disease that prevents the heart from easily pumping blood to the rest of the body. About 6.2 million Americans suffer from heart failure, including men and women. According to a recent study conducted by JAMA, the number of maternal deaths in the United States is high, 10% of them being related to cardiomyopathy, but 60% of them are preventable through treatments optimal and coordinated care. That's exactly what this team had to offer this patient.

For seven weeks, the mother's care was managed by several teams, including cardiologists specializing in heart failure and the OB team. To develop a comprehensive care plan, the rest of the team consisted of intensive care physicians, interventional cardiologists, cardiothoracic surgeons, specialized nurses, catheterization and surgical laboratory staff, as well as thoracic and neonatal intensive care units, pharmacists, advanced practice clinicians and cardiovascular nurses. The social workers also supported the patient and his wife.

"We had two goals: to let the baby mature enough for him to have better results, and then keep the mother as stable as possible with his terribly weak heart muscle," Rasmusson said.

The baby delivered at 29 weeks, approximately 11 weeks earlier. The team knew that the delivery was risky and required advanced planning in advance. They held two meetings prior to the delivery date to discuss the sequence of events and roles of all members of the team, including mechanically supporting the mother's heart during an intervention. cesarean section in the cardiac catheterization laboratory.

The complicated delivery sequence included intubation, insertion of a pulmonary artery catheter, insertion of a temporary mechanical support, l & # 39; Cesarean delivery, sending the baby into the neonatal intensive care unit with his father and intensive care monitoring after delivery.

After delivery, with the mother's heart remaining very weak, a left ventricular badist device (LVAD) was implanted, which gave her a more durable mechanical support and allowed her to pbad through. from a heart transplant, which she received eight months after delivery.

The baby is now almost five years old and the baby and the mother are fine, said Rasmusson.

"The patient in this unique case had the best possible outcome we all hoped for," she added. "Only thanks to the experts of our various teams, the wealth of their skills and experience, and our commitment to provide the best care we can, that it is possible for women as in this case and for others like her. "

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This story was published on: 2019-03-17. To contact the author, please use the contact information in the article.

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